The patient who has the first MERS-CoV (Middle East respiratory syndrome coronavirus) case in the United States is a US citizen in his 60s who lives and works in Saudi Arabia and was visiting relatives in Indiana when he fell ill, but he is now improving rapidly, federal, state, and global health officials revealed today.

Officials also reported at a press conference that all the patient's healthcare worker contacts have tested negative for the virus so far, and no illness has been reported among airline passengers who traveled with him from Saudi Arabia to Chicago and have been contacted.

As was reported when the case was announced on May 2, the man is a healthcare worker at a hospital in Riyadh. Today officials said there were MERS-CoV patients at the hospital, but the patient was not aware of having had contact with them.

The patient is recovering at Community Hospital in Munster, Ind., where today's press briefing was held. He flew on Apr 24 from Riyadh to London and on to Chicago, and then took a bus from Chicago to Indiana.

The man got sick with flu-like symptoms on Apr 27 and sought treatment at the Munster hospital the evening of Apr 28, officials said. He tested positive for MERS on May 2. Because of federal privacy rules, officials have revealed little information about the patient.

The World Health Organization (WHO) said today, however, that the man had an onset of fever on Apr 14, which means he apparently already had symptoms before flying to Chicago on Apr 24. The agency said the man is in his 60s, information not shared by health authorities in the United States.

The WHO also said that the man was placed in a negative-pressure room with airborne precautions on Apr 29. Computed tomography of the man's chest that day showed infiltrates in both lungs. The next day he was placed in full isolation, with standard, contact, and airborne precautions, the agency said.

Patient may go home soon

Alan Kumar, MD, chief medical Information officer at the hospital, said the man no longer needs supplemental oxygen, as he did earlier. "We expect him to be going home soon," he said.

Officials said about 50 hospital employees who had contact with the patient before he was diagnosed have been tested for MERS-CoV and are in home isolation and will stay there for 14 days, which is considered the longest possible incubation period for the virus.

"The state lab has tested all the samples of the healthcare workers at this hospital, and preliminary results are negative," said Indiana State Health Commissioner William Vanness II, MD, at the press conference.

"At this point it appears that MERS picked the wrong hospital, the wrong state, and the wrong country to try to get a foothold," he added.

Daniel Feikin, MD, a medical epidemiologist with the Centers for Disease Control and Prevention (CDC) and leader of the CDC response team for the case, said the agency has obtained lists of the airline passengers who shared a plane with the patient and is working with state health departments to contact them.

The CDC also issued a Health Alert Network (HAN) advisory on May 2 after the case was reported to notify health officials of the possibility of MERS cases in the country and "to increase their index of suspicion to consider MERS-CoV infection in travelers from the Arabian Peninsula and neighboring countries."

The alert said that, for patients meeting specific criteria, testing for MERS-CoV and other respiratory pathogens can be done simultaneously.

Most passengers contacted

Almost three fourths of the passengers have been contacted so far, and none have reported symptoms, Feikin reported. He said the CDC is working with state officials to contact passengers on the bus he rode on. About 100 airline passengers and 10 bus passengers are involved, he added.

The case comes amid Saudi Arabia's battle with a high volume of MERS cases over the past several weeks, including many in healthcare workers. Jeddah and Riyadh are the two leading hot spots.

In response to questions, Feikin said the patient "does not recall working directly with patients who had MERS, but in a hospital that did have MERS cases." He declined to name the Riyadh hospital where the man worked.

He and the other officials stressed that MERS has achieved person-to-person transmission only among close-contact healthcare workers and family members. "There's no evidence that it's gone beyond that to a third or fourth generation [of cases] in the community," he said.

Asking the right questions

In response to a question about how the case was recognized quickly, Kumar said, "It was all about asking the right questions." He said the hospital consulted specialists the morning after the patient was admitted, and the consultants contacted state health officials and the CDC about the case.

Without saying whether the patient himself suspected MERS, Kumar said, "The family was part of the interview process that led to the diagnosis."

Officials revealed that the patient's visit to the United States was planned. They reported that precautions will be taken to protect others when he travels back to Saudi Arabia.

"We're still working it out with the CDC so that when he does travel back to Saudi Arabia he'll be safe to do so," said Kumar.

Feikin noted that the CDC is not recommending any restrictions on travel to or from Saudi Arabia, though the agency is providing guidance to help airline and port-of-entry personnel identify possible case-patients. The agency updated its MERS travel guidance on May 2.

The Community Hospital staff received multiple commendations at the briefing for what Feikin called their "rapid and efficient response to the introduction of the MERS virus in the United States."

Indiana Gov. Mike Pence commented, "Because of the efforts first and foremost of the leadership here at Munster Community Hospital I'm confident that we're well along the way to containing and securing the virus from any further spread in our state."

Andrea Farmer, a hospital spokeswoman, said the required home isolation for 50 hospital staff members is not having a big impact on the hospital. "The hospital has more than 3,000 employees, so it hasn't really affected the staffing," she told CIDRAP News. "They have a pool of floaters they can pull from when something like this occurs."